Adults with alcohol-related liver disease may face a nearly fivefold higher risk of cirrhosis and a more than twofold higher risk of hepatocellular carcinoma compared with those without steatotic liver disease or cardiometabolic risk factors, according to a recent study.

In the prospective study, published in The American Journal of Gastroenterology, investigators evaluated the long-term risks of cirrhosis and hepatocellular carcinoma (HCC) among subtypes of steatotic liver disease (SLD). The cohort included 332,175 adults from a health screening program in Taiwan, followed for a median of 16 years. The participants were stratified into metabolic dysfunction-associated SLD (MASLD), MASLD with excessive alcohol consumption (MetALD), alcohol-related liver disease (ALD), and non-SLD groups based on ultrasonography, alcohol intake, and cardiometabolic risk factors.

The incidence rates of cirrhosis were 282.0, 145.6, and 95.4 per 100,000 person-years for ALD, MetALD, and MASLD, respectively, compared with 32.3 per 100,000 person-years in non-SLD participants without cardiometabolic risk factors. For HCC, the rates were 69.0, 52.7, and 30.7 per 100,000 person-years for ALD, MetALD, and MASLD, respectively, vs 7.8 per 100,000 person-years in the same reference group.

Adjusted hazard ratios (HR) for HCC compared with non-SLD without cardiometabolic risk factors were 1.92 (95% confidence interval [CI] = 1.51–2.44) for MASLD, 2.91 (95% CI = 2.11–4.03) for MetALD, and 2.59 (95% CI = 1.93–3.48) for ALD. For cirrhosis, HRs followed a similar pattern, with ALD having the highest HR at 4.74 (95% CI = 4.08–5.52).

The study findings emphasized the role of metabolic dysfunction and alcohol intake in the progression of cirrhosis and HCC. While the results reinforced the need for targeted prevention strategies, the investigators noted that further research is needed to determine effective interventions and refine risk assessment for SLD subtypes.

Full disclosures can be found in the published study.